{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:19:14Z","timestamp":1788149954792,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23DK129776"],"award-info":[{"award-number":["K23DK129776"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30DK56338"],"award-info":[{"award-number":["P30DK56338"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The price of vonoprazan in the United States, as with many newly introduced drugs, is currently high. Here, we examined the cost\u2010effectiveness of vonoprazan clarithromycin triple therapy for treatment of\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Helicobacter pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      in the United States. We compared cure rates and total treatment costs to achieve \u2265\u200990% cure with either vonoprazan or proton pump inhibitor (PPI) triple therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We simulated a theoretical population and compared 4 scenarios comparing vonoprazan 20\u2009mg twice daily or esomeprazole 40\u2009mg twice daily. These included: (1) empiric vonoprazan versus esomeprazole clarithromycin triple therapy, (2) susceptibility\u2010based vonoprazan versus esomeprazole clarithromycin triple therapy, (3) empiric vonoprazan versus esomeprazole clarithromycin triple therapy with treatment failures receiving bismuth quadruple therapy, and (4) susceptibility\u2010based vonoprazan versus esomeprazole clarithromycin triple therapy with treatment failures receiving bismuth quadruple therapy. The prevalence of clarithromycin resistance was estimated at 30%. Cure rates were based on the\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>H. pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      treatment nomogram and drug costs on U.S. 2025 retail prices (i.e., $50 for PPI and $960 for vonoprazan triple therapy).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>With 30% resistance, susceptibility\u2010based therapy was the most effective (cure rate 92%). With empiric therapy, the cure rate with vonoprazan was higher than esomeprazole (88% vs. 77%) but overall costs increased 2.4\u20135.2 times. The cost per 1000 patients receiving vonoprazan was approximately $1000,000 versus $50,000 for esomeprazole. The least expensive, highly effective scenario was empiric esomeprazole triple therapy with treatment failures receiving bismuth quadruple therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Any treatment advantage of vonoprazan over PPI in clarithromycin triple therapy is restricted to those with clarithromycin resistance. Vonoprazan triple therapies cost 2 to 5 times more than a high potency PPI with small gains in cure rates. For susceptible infections, triple therapy using a high potency PPI should be preferred, and the most cost\u2010effective strategy is to reserve vonoprazan for refractory cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hel.70152","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:48:01Z","timestamp":1784710081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High Potency Proton Pump Inhibitor Versus Vonoprazan in\n                    <i>Helicobacter pylori<\/i>\n                    Triple Therapy"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6113-4780","authenticated-orcid":false,"given":"Mimi C.","family":"Tan","sequence":"first","affiliation":[{"name":"Section of Gastroenterology and Hepatology, Department of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-6772","authenticated-orcid":false,"given":"Robert L.","family":"Atmar","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"},{"name":"Section of Infectious Disease, Department of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6908-8317","authenticated-orcid":false,"given":"David Y.","family":"Graham","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(23)00070\u20105"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002968"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562848221138168"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102023\u2010329826"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102036.1998.00378.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncpgasthep1138"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2008.03807.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.13003"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2024.06.038"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265\u2010023\u201001991\u20105"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.05.055"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010023\u201007886\u20105"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl20242"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102019\u2010319954"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.15403\/jgld\u2010222"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12495"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001828"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2024.12.022"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12948"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12554"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102015\u2010311304"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12941\u2010018\u20100281\u2010x"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003607"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1159\/000529622"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12830"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.03.026"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.70013"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001659"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.02.027"},{"issue":"3","key":"e_1_2_8_31_1","first-page":"159","article-title":"Best Practices for \n                     Helicobacter pylori\n                   Management","volume":"20","author":"Graham D. 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